Pyogenic flexor tenosynovitis: costly when missed

Abstract

Pyogenic flexor tenosynovitis is one of the most common cause of hand infections where it can lead to severely disabling complications if not promptly and adequately treated. Flexor tenosynovitis is diagnosed by the presence of 4 pathognomonic signs as described by Kanavel. We present a case of a 44-year-old female patient with a chronic history of non-controlled diabetes mellitus complicated with chronic kidney disease, who present with a non-healing ulcer of the right middle finger. The patient was treated at a local diabetic clinic and was referred to our hospital because the wound did not show any improvement after treatment at the clinic. The wound was consulted as a diabetic ulcer, but further examination by the attending orthopaedic surgeon revealed a severely infected hand showing the classical signs of a pyogenic flexor tenosynovitis. Disability of the arm, shoulder and hand (DASH) score at the time of admission was 89.2 and an operation for debridement was scheduled. Intra-operative findings showed diffuse infection and the finger was unsalvageable, so a ray amputation was performed to the affected finger. The patient was discharged 2 days after the surgery and upon 2-month regular follow-up the wound healed with a DASH score of 28.2. Flexor tenosynovitis is a disease that normally have a benign course if treated promptly and correctly. We present one of the worst outcomes that can happen to a normally benign course of flexor tenosynovitis if it is complicated by underlying diseases and a late onset of treatment